Liaison and Engagement Consultant Report

1. Liaison and Engagement Consultant Report Presentation to the FMEC PG Steering Committee andPG Deans Advisory Committee February 7, 2011

2. Completed Consultations (Jan 31/2011) * Deans, PG Deans, UG Deans, Program Directors, Education Councils, etc. FMEC Postgraduate Project 2 Liaison and Engagement

3. Completed Consultations (cont’d) FMEC Postgraduate Project 3 Liaison and Engagement

4. Mandate of the LEC Team • Liaise between the FMEC PG Steering Committee and the Canadian PGME community • Raise awareness of project • Solicit issues, concerns, priorities and successes FMEC Postgraduate Project 4 Liaison and Engagement

5. Organization of the Comments • Organized under six broad themes: • Strengths of the PGME system • Purpose of PGME in Canada • Governance and processes • Pedagogy • Transitions • Financial and human resources FMEC Postgraduate Project 5 Liaison and Engagement

6. Organization (cont’d) • Significant overlap across many themes – but issues have generally been identified under only one theme. • Vulnerabilities, risks and opportunities are grouped together under themes. • All “blue sky” ideas are provided in appendix to the LEC report FMEC Postgraduate Project 6 Liaison and Engagement

7. Interpretive Cautions • Stakeholders were asked for opinions and ideas – not evidence • Counts are not provided: • The number of participants in each meeting varied, and not all opinions were consensus opinions • Priorities are not assigned: • For similar reasons, we could not assign priorities or weights to the issues FMEC Postgraduate Project 7 Liaison and Engagement

8. 1. Strengths • University-based system: • Focus on education over service delivery • Focus on evidence-based practice • Exposure to clinical research • Accreditation process: • National standards create consistent quality • Rigor of standards creates high quality • On-site, peer reviews are valued FMEC Postgraduate Project 8 Liaison and Engagement

9. 1. Strengths (cont’d) • CanMEDS: • Keeps focus on all competencies • Less frequently mentioned: • Scope and quantity of clinical exposure • National CaRMS match • Quality and dedication of PGME faculty FMEC Postgraduate Project 9 Liaison and Engagement

10. 2. Purpose of PGME • Disconnect between society’s needs and PGME “outputs”: • Trend to specialization when generalists are needed • Need for focus on chronic disease management • Need for greater focus on geriatrics and mental health, rather than surgery and paediatrics • Need to address crisis in mental health, aging population, and marginalized populations. FMEC Postgraduate Project 10 Liaison and Engagement

11. 2. Purpose of PGME (cont’d) • Need for stronger patient focus: • Put needs of patients before the needs of residents • Achieve full potential of the CanMEDS framework • Embrace inter-professional care and continuity of care in a meaningful way • Pay more than lip service to patient safety and patient satisfaction • Develop effective strategies to recruit and retain physicians in rural, remote and northern communities (role of FP at risk in some communities) FMEC Postgraduate Project 11 Liaison and Engagement

12. 2. Purpose of PGME (cont’d) • Need for a Health Human Resources Plan: • National initiative • Data-driven, reflecting population demographics • Reflective of changes in models of care, advances in technology and new research. • Involving all primary health care professions • Change in educational strategy: • Educate health professionals to span the boundaries between specialties rather than extended specialty education FMEC Postgraduate Project 12 Liaison and Engagement

13. 3. Governance and Processes • Complex governance structure should be streamlined • Accreditation processes: • Perceived as onerous • Desire for more than just written feedback • Can contribute to unnecessarily protracted training • Leadership: • Need to “step up to the plate” in health human resources planning • Respond to erosion of public accountability within medical profession FMEC Postgraduate Project 13 Liaison and Engagement

14. 3. Governance and Processes • Student Selection: • Although a UGME issue, the impacts on PGME are profound • Need for greater emphasis on: • Desired characteristics related to non-medical expert CanMEDS roles • Probability of practising in remote or rural locations • More career counselling is desired to match interests, aptitudes and employment opportunities FMEC Postgraduate Project 14 Liaison and Engagement

15. 3. Governance and Processes (cont’d) • Resident Assessment • Need for more information to follow learners from UG to PG to practice • More frequent and ongoing assessment, and less emphasis on final examinations • Need for development of self-assessment skills • “Unionization” of resident population reportedly affecting educators’ motivation to provide meaningful assessments FMEC Postgraduate Project 15 Liaison and Engagement

16. 3. Governance and Processes (cont’d) • Resident Assessment • Need for more information to follow learners from UG to PG to practice • More frequent and ongoing assessment, and less emphasis on final examinations. • Need for development of self assessment skills • “Unionization” of resident population reported affecting educators’ motivation to provide meaningful assessments • No reliable models or tools for teaching and assessment of CanMEDS competencies, and inconsistent appreciation of CanMEDS among supervisors FMEC Postgraduate Project 16 Liaison and Engagement

17. 3. Governance and Processes (cont’d) • Accreditation • Concerns regarding standards, structure and time-intensive administrative burden of accreditation-related processes: • Barrier to innovation and flexibility • For some specialties, standards believed to be no longer relevant for contemporary practice. • Process is onerous for participating universities FMEC Postgraduate Project 17 Liaison and Engagement

18. 3. Governance and Processes (cont’d) • Length of Training • Specialty programs generally perceived as unnecessarily protracted: • Trend to subspecialization and complexity of medical practice • Desire for one or more fellowships (improve employment options and/or not yet confident to enter independent practice) • Entering practice in mid-thirties is unprecedented in other professions • Trend to shorter work week for residents may lead to longer training if approach to education is not radically altered • Suggested strategies to shorten training: • Graduated licensure • Funded sabbaticals to acquire additional credentials FMEC Postgraduate Project 18 Liaison and Engagement

19. 3. Governance and Processes (cont’d) • Streaming • Much discussion – and little consensus – on current streaming practices • Suggested streaming strategies included: • Choose a specialty later in training (instead of second year of medical school) • Allow medical students to begin specialization immediately • Provide flexibility in the system so that student or resident can change specialties mid-stream • Tailor training to meet the individualized needs of the learner • Reintroduce the rotating internship • Remove requirement of generalist courses for technical specialist FMEC Postgraduate Project 19 Liaison and Engagement

20. 3. Governance and Processes (cont’d) • Flexibility of Training • Need for more flexibility within the system: • More flexible and individualized career paths for residents • Opportunity to re-enter formal education after graduation • Flexibility to change or introduce programs at local or regional level FMEC Postgraduate Project 20 Liaison and Engagement

21. 3. Governance and Processes (cont’d) • Resident Association Agreements • Perceived to have gone beyond wellness issues and are creating issues for educators • Shorter work week has many repercussions: • Potential for longer training time • Reduction of service component affecting hospitals’ manpower and resident remuneration • Impact on continuity of care FMEC Postgraduate Project 21 Liaison and Engagement

22. 4. Pedagogy • Models of Education: • Desire for more innovative models of education, including competency-based education • Desire for more collaboration and harmonization across jurisdictions and institutions (including sharing of materials and best practices) • Curriculum Improvements • Need for more effective teaching of inter-professional and intra-professional care • Need to teach about clinical systems FMEC Postgraduate Project 22 Liaison and Engagement

23. 4. Pedagogy (cont’d) • Faculty Development: • Educators feel they do not have skills or tools to assess non-medical expert competencies • Trend to distributed sites creates challenges for ensuring quality of teaching faculty across all sites • Adoption of Technology: • Use of simulation • Web-based learning, especially to support DME • Use of telecommunications and social networking FMEC Postgraduate Project 23 Liaison and Engagement

24. 4. Pedagogy (cont’d) • Competency-based Education: • Considerable interest in CBE, especially to shorten training period and contribute to ongoing rather than episodic assessment • Concern about logistical implications (e.g., variable length of rotations, unpredictability of length of rotations and timing of completion) • Concern that focus would shift to those competencies that are easily quantified (e.g., technical expertise and knowledge) FMEC Postgraduate Project 24 Liaison and Engagement

25. 4. Pedagogy (cont’d) • Distributed Medical Education: • Perceived as necessary – to increase capacity for PGME • Perceived as desirable – to better prepare residents for community-based practice • Creates challenges for: • Faculty development and support • Accreditation processes • Identifying and dealing with poor resident performance FMEC Postgraduate Project 25 Liaison and Engagement

26. 4. Pedagogy (cont’d) • Transitions: • Need more emphasis on continuous learning – from admission to retirement • Transitions are too abrupt – need strategies to smooth such as: • Rotating internship • Graduated licensure • More gradual reduction of supervision during residency • More emphasis on life-long learning, perhaps reinforced by a modified fee schedule • Better support to independent practice FMEC Postgraduate Project 26 Liaison and Engagement

27. 5. Human and Financial Resources • Human Resource Shortages • Trend to DME is frustrated by shortage of community-based preceptors: • Reduces physician time available to meet clinical workload • Fee schedule does not remunerate for teaching time • “Volunteerism” is not a sustainable strategy • Trend to shorter work week makes teaching less attractive for physicians in academic centres as well (due to reduced contribution to service delivery) FMEC Postgraduate Project 27 Liaison and Engagement

28. 5. Human and Financial Resources (cont’d) • Issues with Current Funding • PGME is subsidized by clinical practice plans and hospitals • Funding for PGME has not kept up with inflation or growth • Funding does not recognize additional resources to supervise, assess and remediate IMGs • Inconsistent remuneration policies, especially for community-based preceptors FMEC Postgraduate Project 28 Liaison and Engagement

29. 5. Human and Financial Resources (cont’d) • Remuneration for Residents • Residents are seeking consistent remuneration across programs and provinces • Residents also looking for additional financial, educational, personal and developmental supports • Other stakeholders suggested remuneration is for service delivery, and as education to service ratio increases, remuneration should decrease FMEC Postgraduate Project 29 Liaison and Engagement

30. 5. Human and Financial Resources (cont’d) • Continued Financial Pressures • Expectation that current fiscal pressures will persist in medium term, resulting in risk of reduced funding for hospitals, universities and physicians • Need to demonstrate that medical education is as cost-effective as possible: • Use technology to reduce labour intensity • Work with other health professions to ensure all professions working to maximum scope of practice FMEC Postgraduate Project 30 Liaison and Engagement

31. Round 2 Consultations • Purpose: • To discuss the FMEC PG Steering Committee's draft recommendations as they emerge • Stakeholders are expecting a second round of consultations FMEC Postgraduate Project 31 Liaison and Engagement

32. Round 2 Consultations (cont’d) • Suggested Approach to Round 2: • Circulate recommendations electronically, soliciting input on overall content and direction and identify any major omissions • Conduct additional consultations with up to 10 national organizations to solicit feedback • Organize ‘town hall’ meetings at each of the 17 medical schools to solicit feedback • Participate in the CCME (May 2011) and ICRE (Sept 2011) FMEC Postgraduate Project 32 Liaison and Engagement

33. Comments and Questions?